Violence in Psychiatry

9781316135839

Focusing on violence from assessment, through underlying neurobiology, to treatment and other recommendations for practice, this book will be of interest to forensic psychiatrists, general adult psychiatrists, psychiatric residents, psychologists, psychiatric social workers and rehabilitation therapists.

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Every effort has been made in preparing this book to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.

Introduction

For decades, violence and aggressive behavior have been identified as pressing issues facing institutional settings such as psychiatric hospitals and prisons. State psychiatric hospitals in California are no different. The California Department of State Hospitals (DSH) includes five hospitals that house an average of 5600 adult patients. During the 2013 calendar year, there were 3377 incidents of aggression perpetrated on other patients and 2596 incidents of aggression directed toward staff members. Approximately 3% of these assaults were sufficiently severe that the patient or staff member required medical treatment at an outside hospital or emergency room. Consistent with most existing research, attempts to reduce this rate of violence have typically involved medication algorithms or psychosocial methods to treat the aggressive patient. These various interventions stem from the view that violence is due to the psychiatric symptoms, characterlogical features, or behaviors of a disordered patient. The existing research highlights the necessity of a second generation of violence interventions. Specifically, this second-generation intervention would encompass a broader view and conceptualize inpatient aggression as an ecological problem that combines treatment for aggressive patients with environmental and situational interventions. In addition to treating the patient, environmental interventions treat the ward and treat the hospital in a way that mitigates violence and reduces opportunities for aggression.

Ecology is defined as the study of interactions between individual organisms as well as relationships between organisms and their physical surroundings. This study includes the smallest bacteria living on a leaf to each individual tree to the entire forest. The connections between plants, animals, air, elevation, light, and a myriad of other factors are all analyzed as an integrated whole [1]. Moreover, small changes in an ecosystem can cascade into ramifications for all other species in an ecosystem. Previous theories of human behavior have also drawn from this broader ecological view. For example, Bronfenbrenner [2] coined the term “ecological systems theory” to describe how a child’s development is influenced by his or her family and school, but also his or her neighborhood, cultural values, statewide economy, and country’s political system. Aggression within hospitals, we argue, is related to patients’ psychiatric symptoms as well as their interactions with other patients, staff members, the ward milieu, and hospital policies, similar to the delicate balance of ecosystems. After reviewing the existing research on the role of environment in hospital wards and hospitals, barriers to adopting an ecological approach are identified, and an example of one hospital’s attempt to implement an ecological approach is described.

Colin A. HodgkinsonLaboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA

Brian J. HoloydaDepartment of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, USA

Matthew J. HoptmanSchizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, Department of Psychiatry, New York, USA, and University School of Medicine, and Department of Psychology, City University of New York, New York, USA

K. Luan PhanDepartment of Psychiatry, University of Illinois College of Medicine, Mental Health Service Line, Jesse Brown Veterans Administration Medical Center, and Departments of Psychology, and Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, Illinois, USA

Barbara E. McDermottDepartment of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, USA

Jonathan M. MeyerDepartment of Psychiatry, University of California–San Diego, San Diego, California Department of State Hospitals, and Patton State Hospital, California, USA

John MonahanSchool of Law, University of Virginia, Charlottesville, Virginia, USA

Matteo PardiniDepartment of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, and Magnetic Resonance Research Centre on Nervous System Diseases, University of Genoa, Genoa, Italy

Katalin A. SzaboDepartment of Psychiatry, San Mateo Health System, San Mateo, and Behavioral Health and Recovery Services, San Mateo, and Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA

John TullyDepartment of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

Stephen C. P. WongDepartment of Psychology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, School of Medicine, University of Nottingham, Nottingham, UK, and Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia